=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275322331
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EFFECTUAL HOME CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2025
-----------------------------------------------------
Last Update Date | 05/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 104 HOMEWOOD CT
-----------------------------------------------------
City | MILLBROOK
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36054-2329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-577-1658
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 104 HOMEWOOD CT
-----------------------------------------------------
City | MILLBROOK
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36054-2329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-577-1658
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ADMINISTRATOR
-----------------------------------------------------
Name | KIMBERLY MCCANTS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 251-577-1658
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------